Joint Pain

Also known as Arthritis

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credits: Sourced from the website Patient UK, authored by Dr Oliver Starr (see below). Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

Overview

Arthritis means pain in a joint (like your knee, hip, elbow or fingers). It is a common problem and generally affects older people, although there are some rare conditions that cause arthritis in children and teenagers. There are lots of types of arthritis. Some give you short-term aches in the joints and then resolve completely, others can cause long-term problems and permanently affect how your joints move.

What is arthritis?

Arthritis means inflammation of joints. Arthritis is very common. There are many causes of arthritis. Children and adults of all ages can be affected by arthritis, although the most common type is osteoarthritis and that affects older people. 

Arthritis may affect just one joint, a few joints or many joints. Each cause of arthritis tends to have a typical pattern in terms of which joints are affected and the age of people most likely to be affected.

Understanding joints

A joint is situated where two bones meet. Joints allow movement and flexibility of various parts of the body. The movement of the bones is caused by muscles which pull on tendons that are attached to bone. Cartilage covers the end of bones. Between the cartilage of two bones that form a joint there is a small amount of thick fluid called synovial fluid. This lubricates the joint, which allows smooth movement between the bones.

The synovium is the tissue that surrounds a joint. Synovial fluid is made by cells of the synovium. The outer part of the synovium is called the capsule. This is tough, gives the joint stability, and stops the bones from moving out of joint. Surrounding ligaments and muscles also help to give support and stability to joints.

Causes

What are the causes of arthritis?

The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. However, there are many different causes of arthritis.

The following list includes some of the common conditions that mainly affect joints:

• Rheumatoid arthritis (RA) causes inflammation, pain, and swelling of joints. Persistent inflammation over time can damage affected joints. The severity can vary from mild to severe. The earlier treatment is started, the less joint damage is likely to occur.
  
  
• Osteoarthritis (OA) causes pain and stiffness in joints. Symptoms may be helped by exercises, some physical devices and treatments, and losing weight if you are overweight.
  
  
• Septic arthritis is an infection in a joint. Symptoms include pain and tenderness over a joint, pain on moving the joint, and feeling unwell. It is an uncommon infection but very serious. Emergency treatment in hospital is needed.
  
  
• Ankylosing spondylitis is a form of arthritis. It mainly affects the lower back. Other joints and other parts of the body are sometimes affected. Treatment includes regular exercise and anti-inflammatory medicines. The severity of ankylosing spondylitis varies from mild to severe. An eye complication called uveitis can be serious but can be treated successfully if treatment is given promptly.
  
  
• Gout causes attacks of pain and swelling in one or more joints. An anti-inflammatory painkiller usually eases an attack quickly. Lifestyle factors may reduce the risk of having gout attacks. These include losing weight (if overweight), eating a healthy diet, and not drinking much alcohol or sugar-sweetened soft drinks.
  
  
• Calcium pyrophosphate is a substance produced in the cartilages of the joints. It can become deposited as crystals on joint tissues. This is called calcium pyrophosphate deposition (CPPD). CPPD can cause a number of problems of which the most well-known is pseudogout. This is almost identical to gout, causing attacks of pain and swelling in one or more joints. Some people get damage to the joint, causing a type of long-term arthritis. CPPD may cause no symptoms and is sometimes picked up on an X-ray done for an unrelated condition. Unlike gout, there is no special therapy for pseudogout.
  
  
• Psoriatic arthritis causes inflammation, pain, and swelling of joints in some people who have psoriasis (a skin condition). Other parts of the body may also be affected. For example, inflammation may also affect tendons and ligaments. The severity can vary from mild to severe. In some cases, affected joints become damaged which can cause disability.
  
  
• Reactive arthritis means that you develop inflammation in joints after you have had an infection in some other part of the body. Other symptoms usually develop in addition to the arthritis. Symptoms commonly last 3-6 months. In some cases, the arthritis persists long-term. The term Reiter's syndrome is used when arthritis, urethritis and conjunctivitis occur at the same time (this is rare).
  
  
• Juvenile idiopathic arthritis (JIA) is an unusual condition in which joint inflammation occurs in children under the age of 16 years. It lasts for at least six weeks. Arthritis causes inflammation, pain and swelling of the affected joints. The severity can vary from mild to severe. The earlier the treatment is started, the less joint damage is likely to occur.

Conditions similar to arthritis

There are some medical problems which don't affect the joints predominantly, but can cause joint problems as they progress. 

Examples include:

• Systemic lupus erythematosus (SLE) can cause various symptoms, the most common being joint pains, skin rashes and tiredness. Problems with kidneys and other organs can occur in severe cases.
  
  
• Gut (bowel) conditions - Some gut conditions, especially inflammatory bowel diseases such as Crohn's disease and ulcerative colitis, may cause arthritis.
  
  
• Cervical spondylosis is a 'wear and tear' of the bones (vertebrae) and discs in the neck. It is a normal part of ageing and does not cause symptoms in many people. However, it is sometimes a cause of neck pain. Symptoms tend to come and go. In severe cases, the degeneration may cause irritation or pressure on the spinal nerve roots or spinal cord. This can cause arm or leg symptoms.
  
  
• Polymyalgia rheumatica (PMR) causes pain, stiffness and tenderness in large muscles, typically around the shoulders, upper arms and hips. The cause is not known. Some people with PMR develop a related condition called giant cell arteritis (GCA) which can be more serious.
  
  
• Fibromyalgia causes pains and tenderness in many areas of the body, and tiredness. You may also have other symptoms. 

Arthritis symptoms

The symptoms of arthritis vary depending on the nature and severity of the underlying cause.

The symptoms include:

• Joint pain, tenderness and stiffness.
• Restricted movement of the joints.
• Warmth and red skin over the affected joint.
• Weakness and muscle wasting around the joint.

Arthritis treatment

There are treatments available for all forms of arthritis. However, the treatment will depend on the cause of arthritis. Treatments may include medicines, physiotherapy and surgery. Some causes of arthritis only need treatment for a short time. Other causes of arthritis may need lifelong treatment. For osteoarthritis, if it affects the hip or the knee, surgery can be done to replace the entire joint.

Prognosis

What is the outlook (prognosis)?

Some types of arthritis are short-lived and don't leave you with any problems. Examples are reactive arthritis, which usually goes away by itself and juvenile arthritis which clears up usually without any long-term problems.  Other types come and go, like gout. Rheumatoid arthritis tends to stay with you for the long term, but can be controlled with medication. And osteoarthritis is a consequence of getting old, but can be solved if it's suitable to have a joint replacement.

About the author

Dr Oliver Starr

MBChB, BMedSc, MRCS, MRCGP, DRCOG

Dr Oliver Starr is a general practitioner in Hertfordshire.  He is an undergraduate tutor at University College Medical School, a general practice appraiser and a case assessor at the National Perinatal Epidemiology Unit, University of Oxford.  Other interests include medical law, particularly regarding clinical negligence.  Dr Starr is a council member of the Cameron Fund charity.

Recommended websites

For further reading go to:

• Arthritis - a term often used to mean any disorder that affects joints

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